Active NPI
Elizabeth Petropoulos, PT
- Pediatric Physical Therapist
- Itasca, IL
National Provider Identifier
1104955277
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 070003531
- Practice address
- 6N406 Baker Dr
Itasca, IL 60143-1936 - Phone
- (847) 917-5210
- Fax
- (847) 481-0232
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 070003531 | IL | Primary |
Addresses
Primary practice location
6N406 Baker Dr
Itasca, IL 60143-1936
Mailing address
6N406 Baker Dr
Itasca, IL 60143-1936
Phone (847) 917-5210
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007153719 | Other | IL | AETNA |
| 1871690446 | Other | NPI TYPE 2 | |
| 4532188 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070003531 | IL | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| On Small Feet, PC | Pediatrics | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743984000000",
"number": "1104955277",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6N406 BAKER DR",
"city": "ITASCA",
"state": "IL",
"postal_code": "601431936",
"telephone_number": "847-917-5210",
"fax_number": "847-481-0232"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6N406 BAKER DR",
"city": "ITASCA",
"state": "IL",
"postal_code": "601431936",
"telephone_number": "847-917-5210",
"fax_number": "847-481-0232"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETROPOULOS",
"first_name": "ELIZABETH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2025-04-07",
"certification_date": "2025-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "IL",
"license": "070003531",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007153719",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI TYPE 2",
"identifier": "1871690446",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "4532188",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Itasca, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.